标题：磁共振动态增强图像及定量参数诊断富细胞型子宫肌瘤的价值及与生物学行为标志物的相关性

      作者：郭伟 1，吕培培 1，谷梅兰 1，董安珂 1，陈亚龙 1，肖新广 1，上官建伟 2    郭伟 1，吕培培 1，谷梅兰 1，董安珂 1，陈亚龙 1，肖新广 1，上官建伟 21.郑州市中心医院放射科，河南 郑州 450000；2.新郑市公立人民医院放射科，河南 新郑 451151

      卷次： 2024年35卷4期

      【摘要】 目的 探讨磁共振动态增强图像(DCE-MRI)及定量参数诊断富细胞型子宫肌瘤(CUL)的价值及其与生物学行为标志物的相关性。方法 选取 2021年6月至2023年6月于郑州市中心医院就诊的83例CUL患者作为观察组，另选取同期、同年龄段普通型子宫肌瘤患者83例作为对照组，两组患者均进行DCE-MRI检查，并测定观察组患者病灶组织p16、血管内皮生长因子(VEGF)、Ki-67。比较两组患者的DCE-MRI定量参数[速率常数(Kep)、血管间隙容积分数(Vp)、容量转运常数(Ktrans)、血管外细胞外间隙容积分数(Ve)、毛细血管表面通透性(PS)、血浆灌流量(Fp)]，采用相对危险度(RR)分析不同水平DCE-MRI定量参数(Ktrans、Kep、Ve、Vp、PS及Fp)对CUL的发病风险，采用受试者工作特征曲线(ROC)、决策(DCA)曲线评估DCE-MRI定量参数对CUL的诊断效能；比较不同 p16、VEGF、Ki-67表达CUL患者的DCE-MRI定量参数，采用Pearson分析DCE-MRI定量参数与 p16、VEGF、Ki-67的相关性。结果 观察组患者的Ktrans、Kep、Ve、Vp、PS及Fp分别为(1.98±0.62) min、(1.99±0.24) min、(0.80±0.17)%、(0.52±0.14)%、(1.24±0.45) mL/min、(2.47±0.46) mL/min，明显高于对照组的(0.96±0.35) min、(1.12±0.43) min、(0.55±0.22)%、(0.29±0.10)%、(0.37±0.12) mL/min、(0.91±0.25) mL/min，差异均有统计学意义(P<0.05)；当Kep、Ktrans、Ve、Vp、PS及Fp高水平时，CUL发病风险是低水平的9.375倍、6.546倍、3.611倍、4.929倍、8.222倍、5.917倍；经ROC分析结果显示，Ktrans、Kep、Ve、Vp、PS、Fp联合诊断CUL的AUC为0.939，大于各参数单独诊断(P<0.05)；经DCA曲线分析结果显示，各参数联合诊断CUL的临床净收益率最高；观察组中p16、VEGF及Ki-67阳性表达患者的Ktrans、Kep、Ve、Vp、PS及Fp明显高于阴性表达患者，差异均有统计学意义(P<0.05)；经 Pearson分析结果显示，Kep、Ktrans、Ve、Vp、PS及 Fp与 p16、VEGF、Ki-67均呈正相关(P<0.05)。结论 DCE-MRI及定量参数对CUL具有一定诊断价值，且与患者p16、VEGF及Ki-67显著相关。
      【关键词】 富细胞型子宫肌瘤；磁共振；动态增强图像；定量参数；诊断；应用价值
      【中图分类号】 R737.33 【文献标识码】 A 【文章编号】 1003—6350（2024）04—0547—06

Value of dynamic contrast-enhanced magnetic resonance imaging and quantitative parameters in the diagnosisof cellular uterine leiomyomas and their correlation with biological behavior markers.
GUO Wei 1, LV Pei-pei 1, GUMei-lan 1, DONG An-ke 1, CHEN Ya-long 1, XIAO Xin-guang 1, SHANGGUAN Jian-wei 2. 1. Department of Radiology,Zhengzhou Central Hospital, Zhengzhou 450000, Henan, CHINA; 2. Department of Radiology, Xinzheng Public People'sHospital, Xinzheng 451151, Henan, CHINA
【Abstract】 Objective To investigate the diagnostic value of dynamic contrast-enhanced magnetic resonanceimaging (DCE-MRI) and quantitative parameters in the diagnosis of cellular uterine leiomyoma (CUL) and its correla-tion with biological behavior markers. Methods A total of 83 patients with CUL who were treated in Zhengzhou Cen-tral Hospital from June 2021 to June 2023 were selected as the observation group, and another 83 patients with ordinaryuterine leiomyoma in the same period and of the same age were selected as the control group. Both groups of patients un-derwent DCE-MRI examination, and the p16, vascular endothelial growth factor (VEGF), and Ki-67 were measured inthe lesion tissues of patients in the observation group. The quantitative parameters of DCE-MRI [rate constant (Kep), vas-cular clearance volume fraction (Vp), volume transport constant (Ktrans), extravascular extracellular space volume fraction(Ve), capillary surface permeability (PS), plasma perfusion flow (Fp)] were compared between the two groups of patients.Relative risk (RR) analysis was used to assess the risk of CUL development with different levels of DCE-MRI quantita-tive parameters (Ktrans, Kep, Ve, Vp, PS, and Fp), and receiver operating characteristic (ROC) and decision curve analysis(DCA) were used to evaluate the diagnostic performance of DCE-MRI quantitative parameters for CUL. DCE-MRIquantitative parameters were compared in patients with different expressions of p16, vascular endothelial growth factor(VEGF), and Ki-67 in CUL, and Pearson analysis was used to assess the correlation between DCE-MRI quantitative param-eters and p16, VEGF, and Ki-67. Results The Ktrans, Kep, Ve, Vp, PS, and Fp in the observation group were (1.98±0.62) min,(1.99±0.24) min, (0.80±0.17)%, (0.52±0.14)%, (1.24±0.45) mL/min, and (2.47±0.46) mL/min, respectively, which weresignificantly higher than (0.96±0.35) min, (1.12±0.43) min, (0.55±0.22)%, (0.29±0.10)%, (0.37±0.12) mL/min, and(0.91±0.25) mL/min in the control group (P<0.05). When Kep, Ktrans, Ve, Vp, PS, and Fp were at high levels, the risk of CULonset was 9.375 times, 6.546 times, 3.611 times, 4.929 times, 8.222 times, and 5.917 times lower than that at low levels,respectively. ROC analysis results showed that the AUC of Ktrans, Kep, Ve, Vp, PS, and Fp in combination for diagnosing ofCUL was 0.939, which was greater than that of individual detection of each parameter (P<0.05). DCA curve analysis re-sults showed that the combined detection had the highest clinical net return rate for the diagnosis of CUL. The Ktrans, Kep,Ve, Vp, PS, and Fp of patients with positive expression of p16, VEGF, and Ki-67 in the observation group were signifi-cantly higher than those of patients with negative expression, and the differences were statistically significant (P<0.05).Pearson analysis results showed that Kep, Ktrans, Ve, Vp, PS, and Fp were positively correlated with p16, VEGF, and Ki-67(P<0.05). Conclusion DCE-MRI and quantitative parameters have certain diagnostic value in CUL, and are significant-ly correlated with P16, VEGF and Ki-67.
      【Key words】 Cellular uterine leiomyomas; Magnetic resonance imaging; Dynamic enhanced image; Quantitativeparameters; Diagnosis; Application value